While on my rural placement, I was involved in running Stay on Your Feet exercise classes numerous times a week. One of the classes was targeted at individuals with a lower functional level so the class was performed mostly in sitting. I was running these classes quite well, with good participation from all individuals. However on one session I decided to vary the routine somewhat as a bit of a change. The new components added more overhead upper limb movements, with all individuals completing these components. After the class some participants commented that they had shoulder problems and the added components were too strenuous.
The next session I reduced the time spent in these overhead upper limb activities and this was received well by the participants. From this experience I have realised that in the group setting it is imperative to always state at the beginning of the class that some activities may not be able to be completed by individuals who have particular injuries and that it is ok for them to sit out that activity or complete an alternative option. It also high lighted the importance of watching for signs that individuals are struggling with exercises and alter the exercise program accordingly. In the future I will always offer alternative exercises for activities that may be challenging and remind participants not to complete exercises that cause pain or discomfort.
Tuesday, December 2, 2008
Monday, December 1, 2008
Look at the bigger picture
In my rural placement, I had a 16 year old patient who had undergone an ACL repair about 8 weeks ago and is now attending outpatient rehab classes. He did his ACL while playing cricket for the school team. Each time he came to rehab, his only question is when can I start cricket again. He was someone who is not really vigilant with HEP and is really desperate to get back to his games. I explained to him that his knee needs time to heal and returning to cricket has to be a gradual process. Each time he came he complained of a knee pain but subjectively reported no change of his activities over the week. His progress was much slower than you would expect for someone at that age who had undergone an ACL repair. His muscle was still weak, he still had poor proprioception, some swelling around the knee and his range had plateud.
After the second session with him, I had a discussion with my supervisor as I suspected something just did not quite add up to the picture. I gave the mum a call and asked her some clarifying questions and all she said is that he still doesn’t do much. Just few days after that, I had another patient who goes to the same school as him asked how is his knee and I told him I can’t really discuss other patient with him. Then he responded jokingly, it must be doing well because he plays cricket now but he plays like a looser. Immediately the picture added up. So the next time he attended rehab, I asked him in an appropriate manner not to make him feel like I am accusing him. He eventually admitted that he started cricket about 3 weeks ago and since then he’s been having the knee pain. I then gave him an intensive education session and told him that if he does not back off from his sport he is going to damage the repairs and potentially not able to ever return to his sport again. He seemed like he had understood me as he said he is going to try and be a bit more active in his rehab. From then on, his swelling reduced and his knee range started improving.
This encounter had highlighted the importance of looking at things at the bigger picture and making sure that it all adds up. It is important to realize that when a patient is not progressing, we have to try and seek the barrier to this so that we are able to achieve better outcomes in the rehabilitation process and prevent any potential risk of further injury.
After the second session with him, I had a discussion with my supervisor as I suspected something just did not quite add up to the picture. I gave the mum a call and asked her some clarifying questions and all she said is that he still doesn’t do much. Just few days after that, I had another patient who goes to the same school as him asked how is his knee and I told him I can’t really discuss other patient with him. Then he responded jokingly, it must be doing well because he plays cricket now but he plays like a looser. Immediately the picture added up. So the next time he attended rehab, I asked him in an appropriate manner not to make him feel like I am accusing him. He eventually admitted that he started cricket about 3 weeks ago and since then he’s been having the knee pain. I then gave him an intensive education session and told him that if he does not back off from his sport he is going to damage the repairs and potentially not able to ever return to his sport again. He seemed like he had understood me as he said he is going to try and be a bit more active in his rehab. From then on, his swelling reduced and his knee range started improving.
This encounter had highlighted the importance of looking at things at the bigger picture and making sure that it all adds up. It is important to realize that when a patient is not progressing, we have to try and seek the barrier to this so that we are able to achieve better outcomes in the rehabilitation process and prevent any potential risk of further injury.
Treat them all the same.
During my neuro placement, I had a new patient and the handover notes was that the patient was a prisoner in shackles, he had two prison guards with him 24/7 and was a left hemiplegia with no sitting balance. The notes also did mention about him having a psych review and that he was diagnosed with bipolar disorder and mild psychosis.
This is my first time having to treat a prisoner in shackles and that really made me worried. We had to get permission from the prison authorities to unshackle the patient for rehabilitation and that made me worried as I had all the “what if’s” running through my head. Well, I tried to calm myself down and felt that if I treated him just like any other patient I will do fine and besides, if anything happens there is two guards to help restrain him. When I met him, I introduced myself and gave him a brief explanation of what the treatment is going to consist of. He did not respond much to what I had said and just looked away. Then I asked him, if he had anything bothering him and his reply was, “like you care”. That is the first time I had met a patient who spoke that way. I then just said politely to him, I’m only here to help and I need him to allow me to. So I asked him again, if he has any concerns? Then he said that his neck been hurting for a week now and it disturbs his sleep at night. I then decided to assess and treat his neck before looking at his sitting balance. He then became more interactive and looked pleased that I actually listened to his concerns and acted upon them. He then appeared more compliant to the treatment session which I thought was impossible at the beginning of the treatment just by the way he appeared to me. He then became a patient in my caseload for the next two weeks I was there. He became more and more compliant each session and this helped his rehabilitation progress smoothly. By the end of the two weeks we achieved sitting balance and I started working on standing balance.
This was an invaluable experience. It had thought me the importance of treating each patient with dignity and respect regardless of what their background is in order to have a positive contribution to the rehab process. Just by listening to him and making him feel that his concerns were important, he became a more compliant patient.
This is my first time having to treat a prisoner in shackles and that really made me worried. We had to get permission from the prison authorities to unshackle the patient for rehabilitation and that made me worried as I had all the “what if’s” running through my head. Well, I tried to calm myself down and felt that if I treated him just like any other patient I will do fine and besides, if anything happens there is two guards to help restrain him. When I met him, I introduced myself and gave him a brief explanation of what the treatment is going to consist of. He did not respond much to what I had said and just looked away. Then I asked him, if he had anything bothering him and his reply was, “like you care”. That is the first time I had met a patient who spoke that way. I then just said politely to him, I’m only here to help and I need him to allow me to. So I asked him again, if he has any concerns? Then he said that his neck been hurting for a week now and it disturbs his sleep at night. I then decided to assess and treat his neck before looking at his sitting balance. He then became more interactive and looked pleased that I actually listened to his concerns and acted upon them. He then appeared more compliant to the treatment session which I thought was impossible at the beginning of the treatment just by the way he appeared to me. He then became a patient in my caseload for the next two weeks I was there. He became more and more compliant each session and this helped his rehabilitation progress smoothly. By the end of the two weeks we achieved sitting balance and I started working on standing balance.
This was an invaluable experience. It had thought me the importance of treating each patient with dignity and respect regardless of what their background is in order to have a positive contribution to the rehab process. Just by listening to him and making him feel that his concerns were important, he became a more compliant patient.
Subscribe to:
Comments (Atom)